YAG Laser Posterior Capsulotomy Research Articles

Evaluation of Vitreoretinal Changes after Nd: YAG Laser Posterior Capsulotomy

Objective: To evaluate the vitreoretinal changes after Neodymium-Yttrium-Aluminum-Garnet (Nd: YAG) laser posterior capsulotomy in patients with posterior capsular opacification after cataract extraction. Patients and Methods: 60 pseudophakic eyes of 50 patients with opacified posterior capsule after uncomplicated cataract surgery treated by Nd: YAG laser posterior capsulotomy. Patients were divided according to the preoperative refractive state of the eye into three groups (Myopic, Hypermetropic, and Emmetropic). Vitreoretinal assessment was done pre and post YAG capsulotomy. Results: The mean best corrected visual acuity (BCVA) had improved after YAG laser posterior capsulotomy in all groups (p < 0.001). Although there was no significant correlation between the refractive state of the eye and changes in CMT measured by optical coherence tomography (OCT) (p < 0.096), however, there was a statistically significant increase in CMT before and one week after YAG posterior capsulotomy (p < 0.001) without any detectable clinical effect on the BCVA. Conclusion: Nd: YAG laser posterior capsulotomy is the standard treatment for posterior capsular opacification [PCO] and gives rise to rapid improvement in visual acuity relieving the symptoms of blurring, photophobia, and glare.

Trans-scleral posterior capsulorhexis in combined lens extraction and silicone oil removal

The aim of this study was to study the safety and efficacy of posterior capsulorhexis in vitrectomized eyes undergoing combined phacoemulsification or irrigation/aspiration and silicone oil removal. This prospective non-randomized interventional study involved 115 silicone-filled eyes of 115 previously vitrectomized patients. All patients underwent combined phacoemulsification or underwent irrigation/aspiration and silicone oil removal, followed by foldable intraocular lens implantation combined with primary posterior trans-scleral capsulorhexis. A 23-gauge trans-scleral vitrectomy probe was used to form the posterior capsulorhexis (vitrectorhexis). Patients were followed for 6 months. Intraocular lenses maintained good centration in the capsular bag during and after trans-scleral posterior capsulorhexis. No complications were observed in the postoperative period regarding lens centration or size of the posterior capsulorhexis. No included eyes needed YAG laser posterior capsulotomy and no recurrent retinal detachment was reported during follow-up. Performing primary trans-scleral capsulorhexis in patients undergoing combined phacoemulsification, or irrigation/aspiration and silicone oil removal, enabled achievement of an early postoperative clear visual axis and prevented the onset of dense postoperative posterior capsular opacification in previously silicone-filled eyes. This technique is reproducible and may facilitate additional intra-operative procedures and uncomplicated postoperative follow-up of retinal detachment patients without requiring YAG laser capsulotomy.

Late capsular block syndrome

The article describes 5 cases of capsular block syndrome (CBS). This late cataract surgery complication has not been sufficiently covered in Russian scientific literature. Diagnostics were based mainly on slit-lamp biomicroscopy and anterior segment optical coherence tomography. In all cases, examination revealed a retro-optical space filled with content of different transparency and homogeneity (transparent liquid, opaque liquid, regenerative lens material). The condition caused visual acuity to decrease in each case. Patient management included follow-ups (2 cases), yttrium-aluminum-garnet laser (YAG-laser) puncture of posterior lens capsule (1 case) or YAG-laser posterior capsulotomy (2 cases). YAG-laser treatment resulted in visual functions improvement.

FREQUENCY OF ACUTE RISE OF INTRAOCULAR PRESSURE FOLLOWING YAG LASER POSTERIOR CAPSULOTOMY

Background: Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. The objective of this study was to determine the frequency of acute rise of intraocular pressure (IOP) following Neodymium-Yttrium Aluminum Garnet (Nd:Yag) laser posterior capsulotomy. Materials &amp; Methods: This cross-sectional study was conducted in the Department of Ophthalmology, HMC, Peshawar, Pakistan, from July-December 2016. Sample size was 325 selected by consecutive sampling technique. Inclusion criteria were all patients having significant PCO after uneventful cataract surgery with intra ocular lens implant. Demographic variables were sex, age groups and age in years. Research variable was presence of acute rise of IOP following Yag laser capsulotomy. Pre-laser assessment included slit lamp examination and recording of IOP with Goldmann applanation tonometer by a single ophthalmologist. IOP was measured 3 hours after Nd: Yag laser capsulotomy. Rise in IOP was labeled when IOP was ≥5 mmhg from baseline. Mean ±SD was used to express quantitative variables like age. Categorical variables were analyzed as frequency and percentage. Goodness-of-fit was applied to compare the frequency of acute rise in IOP between sample and population. SPSS-20 was used for data entry and its analysis. Results: Out of 325 patients, 170(52.3%) were men and 155(47.7%) were women. The mean age of the sample was 44.92 ±23.843 years. A total of 107(32.9%) patients were 20-39 years old whereas 218(67.1%) were 40-70 years. IOP was raised in 61 (18.8%) patients while in 264(81.2%) patients it was not raised. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population. Conclusion: Men were more than women, especially of old age. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population.

ND: YAG LASER

Objectives: To find out the visual acuity outcome after Nd: YAG laser capsulotomy in posterior capsular opacification in pseudophakic patients after cataract surgery. Study Design: Analytical study. Setting: Department of Ophthalmology Khyber Medical University Institute of Medical Sciences / K.D.A Teaching Hospital Kohat. Period: January 2016 to June 2017. Materials and methods: Special proforma was designed for record of patients. PreNd:YAG laser posterior capsulotomy best corrected visual acuity was checked and noted. Anterior and posterior segments examination was done with slit lamp and indirect slit lamp bimicroscopy. Pupils were dilated with tropicamide eye drops. Nd:YAG laser capsulotomy was done. All these procedure were conducted as out door. Patients were put on topical steroid and antiglaucoma drops for ten days to control inflammation and rise in IOP. Post laser best corrected visual acuity was recorded after one month of laser. Results: Total 92 patients were selected with age range from 21 to 83 years. Out of these patients 43(46.74%) were male and 49(53.26%) were female. Post surgical laser period was from 7 months to 13 years. Prelaser best corrected visual acuity of 6/24-6/36 was present in 59(64.13%) patients, 6/60 in 24(26.08%) patients while 9(9.78%) patients had visual acuity of counting finger (CF). Post laser best corrected visual acuity after one month of 6/6-6/9 was recorded in 43(46.39%) patients ,6/12-6/18 in 27(29.34%), 6/24-6/36 in 13(14.13%)and 6/60 &amp; below in 9(9.71%) patients. Conclusion: Post laser best corrected visual acuity is highly improved with Nd:YAG laser capsulotomy in posterior capsular opacification.

This issue of Acta

This issue of Acta

Magnesium Deficiency Effect on the Severity of Autonomic Dysfunction in Mitral Valve Prolapse Patients with Emotional Tension

To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser–assisted capsulotomy versus manual capsulorhexis.Ekol Eye Hospital, Izmir, Turkey.Retrospective case series.Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy.Eighteen eyes had a femtosecond laser–assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669).Nd:YAG posterior capsulotomy performed after femtosecond laser–assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser–created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Long-Term Outcome of Nd:YAG Laser Posterior Capsulotomy in Children: Procedural Strategies and Visual Outcome

To evaluate the long-term outcome of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy after cataract surgery in children. Retrospective case series. Electronic medical records of pediatric patients who underwent Nd:YAG laser posterior capsulotomy between January 1, 2008, and October 31, 2012, and followed up for more than 5 years were reviewed. Thirty-one eyes of 25 patients were included. Only compliant patients assessed during slit-lamp examination and anterior segment photography underwent laser treatment. The mean age at the time of initial laser treatment was 9.04 ± 3.51 years (minimum 56months), and the mean interval between cataract surgery and initial laser treatment was 28.1 ± 22.1months. Posterior capsular openings were successfully made in 26 (83.9%) eyes with a single attempt and in 3 (9.7%) eyes with a second attempt. Overall success rate was 93.5%. The logMAR best-corrected visual acuity was significantly improved from 0.61 ± 0.36 to 0.19 ± 0.25 at 1month posttreatment (P < .0001) and well maintained, at least for 5 years of follow-up, without serious complications. The recurrence of posterior capsular opacity was observed in 7 (24.1%) eyes, which was successfully managed by repeated laser procedure or surgical capsulectomy. By selecting compliant patients and repeated attempts, Nd:YAG laser posterior capsulotomy can be successfully performed in a pediatric population without serious complications. Laser treatment is also a good option for managing recurred posterior capsular opacity. Restored visual acuity can be maintained for at least 5 years.

Uncommon complication following uneventful Nd:YAG capsulotomy

This article reports the development of low grade endophthalmitis following Nd:YAG laser posterior capsulotomy. The patient previously underwent uncomplicated extracapsular cataract extraction with intraocular lens (IOL) insertion and was free of inflammation prior to laser capsulotomy. Anterior vitrectomy with partial capsular bag removal and anterior chamber washout were performed. Samples for cultures were taken and intravitreal antibiotics injected. The patient was managed with topical and systemic antibiotics and steroids. Complete resolution of the inflammation with return of vision to 20/25 was achieved without removal of the intraocular lens or lenticular remnants. The endophthalmitis was responsive to a minimally invasive intervention as well as medicinal therapy including antibiotic agents, and it resolved without any invasive surgical intervention, such as total capsulectomy, IOL exchange or removal and posterior vitrectomy.

The impact of Nd: YAG laser posterior capsulotomy by the use of "the circular pattern with vitreous strand cut" technique on anterior chamber parameters.

The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology. This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, corneal pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500mm (AOD500), AOD at 750mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally. The mean patient age was 55.56 ± 6.33years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all. Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy.

Induction of oxidative stress in human aqueous and vitreous humors by Nd:YAG laser posterior capsulotomy.

To evaluate whether the Q-switched Nd:YAG laser treatment applied in routine capsulotomy elicits oxidative stress in aqueous and vitreous humors. Thirty-six patients who had to undergo a 25 gauge pars plana vitrectomy due to vitreoretinal disorders were enrolled, 15 of them underwent a Q-switched Nd:YAG laser capsulotomy 7d before vitrectomy due to posterior capsule opacification (PCO) (Nd:YAG laser group) while the remaining 21 patients were not laser treated before vitrectomy (no Nd:YAG laser group). Samples of the aqueous and vitreous humors were collected during vitrectomy from all patients for the assessment of oxidative parameters which were compared between the Nd:YAG laser group and no Nd:YAG laser group. Thiobarbituric acid reactive substances (TBARS), a product of membrane lipid peroxidation, nitrite levels, the antioxidative activities of SOD and catalase, the 4-HNE-protein conjugate formation, indicating structural modifications in proteins due to lipoperoxidation, were assessed in aqueous and vitreous samples. In the human vitreous humor TBARS levels are significantly higher in the Nd:YAG laser group compared to the no Nd:YAG laser group and importantly, there is a significant correlation between the TBARS levels and the total energy of Nd:YAG laser used during capsulotomy. Moreover the anti-oxidative activities of SOD and catalase were significantly decreased by Nd:YAG laser treatment, both in aqueous and vitreous humors. In accordance with the TBARS data and anti-oxidative enzyme activities, significantly higher levels of proteins were conjugated with the lipoperoxidation product 4-HNE in the aqueous and vitreous humors in the Nd:YAG laser-treated group in comparison to no Nd:YAG laser group. These data, clearly suggest that any change that Q-switched Nd:YAG photo disruption may cause in the aqueous and vitreous compartments, resulting in a higher level of oxidative damage might be of considerable clinical significance particularly by accelerating the aging of the anterior and posterior segments of the eye and by worsening the intraocular pressure, the uveal, the retinal (especially macular) pathologies.

Incidence of primary peripheral posterior capsular opacification after cataract surgery and posterior capsular opacification in the patients implanted with foldable intraocular lenses.

Preexisting posterior capsular opacification is commonly seen in the developing world due to late presentation of patients for cataract surgery. Patients are implanted with either hydrophilic or hydrophobic IOL. Effect of these IOLs on pre-existing posterior capsular opacification has not yet been reported. To determine the incidence of peripheral preexisting posterior capsular opacity (PPPCO) in patients undergoing cataract surgery and the rate of posterior capsular opacification (PCO) following implantation of hydrophilic and hydrophobic intraocular lens (IOLs). Prospective, observational case study Setting: Tertiary eye care center in central India. 1400 consecutive patients undergoing phacoemulsification of senile cataract between July 2009 and June 2010 discovered to have PPPCO were included in the analysis. Patients were either implanted with hydrophilic (n= 40) or hydrophobic IOL (n=40). Images of the posterior capsule immediately and 3-years postoperatively were compared. Patients were followed up for development of PCO, visual outcome at 3 years and neodymium: YAG laser posterior capsulotomy (NYLPC) rate. Eighty patients were found to have PPPCO (incidence of 5.7%). 47.5% of PPPCOs were from mature senile cataracts (n = 38), 36.2% were from posterior subcapsular cataracts (n = 29) and 16.2% were from posterior polar cataracts (n = 13). NYLPC was performed in 9 patients receiving hydrophilic (22.5%) and 3 patients receiving hydrophobic IOLs (7.5%; p = 0.12). Average time to NYLPC was 18 months in the hydrophilic and 30 months in the hydrophobic group (p = 0.002). Visual outcome was satisfactory at 3-years of follow-up. PPPCO is a frequent occurrence in mature cataract and there is a higher incidence of PCO in PPPCO patients implanted with hydrophilic IOL than with hydrophobic IOL. Therefore, hydrophobic IOL should be considered for patients discovered to have PPPCO during cataract removal.

Improving eye care services with a lean approach.

Effective provision of eye care services in government-financed hospitals is essential to balance the discrepancy between growing demand and limited resources. We aimed to improve efficiency of the treatment protocol for Nd:YAG laser posterior capsulotomy. Predetermined quality targets were a patient-oriented and patient-safe approach and the development of a clinical care process with purposeful use of competences. We utilized a lean process improvement methodology to develop a streamlined Nd:YAG laser posterior capsulotomy treatment protocol. A total of 206 patient visits were evaluated, where the lean-oriented treatment protocol was utilized in 158 of the visits and the conventional (CONV) protocol was followed in 48 of the visits. All baseline variables were comparable between the study groups. Compared to the CONV protocol, implementation of new operational principles shortened the total reception time per patient from 55:36±30:23; 12-136min to 44:40±4:49; 37-54min (mean±SD; range, p=0.040). The per hour number of patients and eyes treated in the operation room improved from 4.7±1.6; 2.6-8.4 patients and 5.5±2.0; 3.5-11.3 eyes to 16.3±2.3; 14.3-19.4 patients (p<0.001) and 18.0±1.6; 16.8-20.4 eyes (p<0.001). The time spent by the operating physician reduced from 8:19±3:06; 3:57-14:30min to 3:01±1:00; 1:34-6:38min in unilateral procedure (p<0.001) and from 8:45±3:55; 5:52-14:10min to 4:40±2:03; 2:38-10:14min in bilateral procedure (p<0.006). Furthermore, the overall patient satisfaction grade improved from 17.3±1.04; 15-18 points to 17.8±0.61; 15-18 points (p=0.001). The lean approach improved the treatment protocol for Nd:YAG laser posterior capsulotomy with substantial reductions in lead times without compromising patient satisfaction.

Comparison of two Nd:YAG laser posterior capsulotomy: cruciate pattern vs circular pattern with vitreous strand cutting.

To investigate the effects and safety of neodymium: yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy with vitreous strand cutting. A total of 40 eyes of 37 patients with symptomatic posterior capsular opacity (PCO) were included in this prospective randomized study and were randomly subjected to either cruciate pattern or round pattern Nd:YAG posterior capsulotomy with vitreous strand cutting (modified round pattern). The best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive error, endothelial cell count (ECC), anterior segment parameters, including anterior chamber depth (ACD) and anterior chamber angle (ACA) were measured before and 1mo after the laser posterior capsulotomy. In both groups, the BCVA improved significantly (P<0.001 for the modified round pattern group, P=0.001 for the cruciate pattern group); the IOP and ECC did not significantly change. The ACD significantly decreased (P<0.001 for both) and the ACA significantly increased (P=0.001 for the modified round pattern group and P=0.034 for the cruciate group). The extent of changes in these parameters was not significantly different between the groups. Modified round pattern Nd:YAG laser posterior capsulotomy is an effective and safe method for the treatment of PCO. This method significantly changes the ACD and ACA, but the change in refraction is not significant. Modified round pattern Nd:YAG laser posterior capsulotomy can be considered a good alternative procedure in patients with symptomatic PCO.

Studying the changes of ocular wavefront aberrations after neodymium

Aimof the study The aim of this study is to evaluate the changes of wavefront aberrations after performing neodymium : yttrium aluminum garnet (Nd : YAG) laser posterior capsulotomy for the management of posterior capsular opacifications. Patients and methods This study is a prospective study that was performed on 100 eyes of 87 patients with posterior capsule opacification following phacoemulsification, in the period from March 2017 to October 2017. A complete ophthalmic examination and optical wavefront imaging were performed to every patient. Patients underwent posterior capsulotomy using Nd : YAG laser with a follow-up period of 6 months. Results There were no significant changes in postoperative refraction at P value more than 0.05 still the best-corrected visual acuity showed a clinically significant at P value less than 0.05. The intraocular pressure was statistically significantly increased on the first postoperative day (P&lt;0.05) but not in other postoperative visits. Regarding higher order aberrations there was a statistically significant improvement in total third-order aberrations (P&lt;0.05), coma aberration (P&lt;0.05), total fourth-order aberrations (P&lt;0.05), spherical aberration (P&lt;0.05), and total higher order aberrations (P&lt;0.05) while quadrafoil and fifth-order aberrations showed no statistically significant changes. Conclusion Nd : YAG laser posterior capsulotomy causes a significantly decrease in wavefront aberrations in patients with posterior capsule opacification.

Effect of Neodymium: Yttrium-Aluminium-Garnet Laser Capsulotomy on Endothelial Cells Count in Posterior Capsular Opacification

Aim: to determine the effect of ND-YAG laser posterior capsulotomies on endothelial cells count in patients attending Ibn Al Haitham teaching eye hospital. Patients and Methods: It is a Prospective non-comparative case series study including patients with clinically significant posterior capsular opacification (PCO) attended Ibn Al Haitham teaching eye hospital from June 2016 to February 2017. Detailed history taking and complete ophthalmic examinations done for all patients, Corneal endothelial cells count was done by using non-contact specular microscopy (topcon sp 3000) before YAG laser, 1 week and 4 weeks after laser to determine the endothelial cells count. Data were analyzed by using ANOVA, F test and paired t – test. Results: Sixty-five eyes of 65 patients presented with clinically significant PCO were included, 40 patients where males (61.5%) and 25 patients females (38.5%). The mean of endothelial cells count before laser was (2047 cell/mm2), 1 week after laser (1938 cell/ mm2) and 4 weeks after laser (1916 cell/ mm2) ,the difference between pre-laser endothelial cells count and 1-4 wks after laser was (109 cell), (131 cell) respectively which is found to be significant (p value 0.04 ). Conclusion: In our study, posterior capsule opacification when treated with ND-YAG laser is associated with statistically significant reduction in the endothelial cells count. The yag laser posterior capsulotomy is noninvasive and effective modality of treatment of PCO but the corneal endothelial cells may be damaged by laser.

Influence of the shape of Nd:YAG capsulotomy on visual acuity and refraction

Background Posterior capsule opacification (PCO) is a common complication after cataract surgery. The need for PCO prevention becomes increasingly important. During the past decades, various forms of prevention have been examined, including general measures during surgery, pharmacological prevention, and by interfering with the biological processes of epithelial mesenchymal transformation (EMT) in lining epithelial cells (LECs). The first-line treatment option is posterior capsulotomy performed with a neodymium:yttrium–aluminum–garnet (Nd:YAG) laser. To evaluate the influence of the size and shape of Nd:YAG laser capsulotomy on visual acuity and refraction. Patients and methods We evaluated 20 eyes of 20 patients treated with Nd:YAG laser posterior capsulotomy for PCO. Patients were divided into two groups according to the shape of capsulotomy: patients with cruciate shape capsulotomies with openings of more than 3 mm (group 1) and patients with circular shape capsulotomies of more than 3 mm. Results The mean number and energy of laser firings were significantly higher in group 2 and significantly lower in group 1 (P=0.011). In the preprocedural spherical equivalent, there was no statistical significance between the two groups (P=0.971). In the postprocedural spherical equivalent also there was no statistical significance between the two groups (P=0.643). Significant change in intraocular pressure following capsulotomy was observed in group 2 (P=0.011), but there was no significant change in group 1. A higher number of patients in group 2 and a lower number of patients in group 1 report floating bodies after YAG laser capsulotomy (P≤0.050 significant). Regarding floating bodies there was statistical significance between the two groups (P=0.025). Best-corrected visual acuity highly significantly improved following capsulotomy in both the groups (P≤0.001). Conclusion Cruciate shape capsulotomy provides improvement in visual function with minimal complications.

To evaluate the effects of Nd:YAG laser posterior capsulotomy on best corrected visual acuity (bcva) and intraocular pressure

Background: Nd:YAG laser is non-invasive and effective means to deal with the posterior capsule opacification.However safe it may have some inherent complications. Rise of intraocular pressure is frequently encountered and incompletely understood complication of YAG laser capsulotomy and documented with conflicting results.Aims and Objective: To assess the efficacy of Nd: YAG laser capsulotomy in term of visual outcome(Best Corrected Visual Acuity) and also study the changes in IOP after the procedure.Materials and Methods: Study evaluated the changes in IOP and visual acuity after Nd-YAG laser capsulotomy in 100 eyes with significant PCO after uncomplicated cataract surgery with IOL implantation. Complete ocular examination including visual acuity, anterior segment examination with slit lamp, fundus and applanation tonometry were performed pre and post-laser in all cases. Posterior capsulotomy was done with VISULAS YAG III Q-switched Nd: YAG laser machine by ZEISS. IOP was recorded before and then at 1hour, 1 Day, 1 week and 1 month post-laser in order to determine the IOP changes.Results: Pre-laser visual acuity ranged from 1/60 to 6/12. Results showed statistically significant improvement in BCVA with 70% patients had BCVA 6/6, 21% had BCVA 6/9 and 8% having BCVA 6/12 post-laser at 1 month. It was observed that 36% of the patients showed no change in IOP while 64% patients showed elevated IOP. Among these 59% patients show rise in IOP that was ≤5 mm Hg while only 5% of the patients had a rise of more than IOP &gt;5 mm Hg. Most of these patients achieved their baseline IOP within 1 day and only 7 % patient had rise in IOP compared to baseline IOP on day 1. None of the patients show elevated IOP after 1 week.Conclusion: Our study showed that Nd: YAG laser posterior capsulotomy provided excellent results in terms of visual improvement and most of the patients had a rise of &lt;5mm Hg which was transient in nature and routine antiglaucoma medication may not be needed in all the patient undergoing Nd;Yag capsulotomy, however caution should be exercised in glaucomatous, aphakic, high myopic and other high risk patients.Asian Journal of Medical Sciences Vol.8(5) 2017 93-97

Resident-performed neodymium:YAG laser posterior capsulotomy

ObjectiveTo investigate the outcomes of resident-performed Nd:YAG laser posterior capsulotomy. DesignCombined retrospective and prospective study. ParticipantsPatients (N = 301) who underwent Nd:YAG capsulotomy by ophthalmology residents at Rassoul Akram Hospital, Tehran, Iran. MethodsAssessment of visual outcomes and complications and the results of second- and third-year residents. ResultsIn the retrospective arm, 131 eyes of 129 patients were enrolled. Mean best-corrected visual acuity (BCVA) improved significantly from 1.15 ± 0.26 to 0.54 ± 0.39 logMAR (p < 0.001). Mean intraocular pressure (IOP) before capsulotomy and at the final visit was 13.1 ± 2.34 mm Hg and 13.6 ± 2.17 mm Hg, respectively (P = 0.30). Retinal detachment occurred in 2 eyes (1.5%). No case of intraocular lens decentration or endophthalmitis was detected. In the prospective arm on 173 eyes of 172 patients, mean pre-YAG BCVA was 1.14 ± 0.25 logMAR and increased to 0.51 ± 0.37 logMAR after surgery (p < 0.001). There was no significant difference between pre-laser IOP measurements compared with the 1-month IOP measurements (P = 0.32). The postoperative changes in mean BCVA and IOP between the second- and third-year residents were not significant; however, the applied laser power, the number of laser spots, rate of incomplete capsulotomies, and the amount of total and central laser-induced IOL pits were significantly higher among the second-year residents. ConclusionsResident-performed capsulotomy appears to be effective with a low complication profile. Despite the lower levels of surgical skills, second-year residents could achieve good visual outcomes. The laser parameters and IOL-related complications improved with increasing surgical experience.

Effect of Nd:YAG laser in the management of posterior capsulotomy after extracapsular cataract extraction

Background: Posterior capsular opacification and other related complications are naturally associated long-term complications of extracapsular cataract extraction (ECCE). Neodymium:Yttrium aluminum garnet (Nd:YAG) laser is an effective treatment for posterior capsulotomy. Objectives: To assess the effects and complication on visual acuity following Nd:YAG laser posterior capsulotomy after ECCE with or without intraocular lens (IOL) implantation. Materials and Methods: A total of 100 patients in between 15 and 85 years age group with significant complications after performing pre-laser assessment were subjected to laser treatment. The treatment is done as an outpatient procedure using VISUALS YAG-II Q-switched Nd:YAG laser. Post-laser treatment follow-up was done after 24 h, 1 week, 1 month, and 6 months interval for the improvement in visual acuity and to detect complications. Results: Pre-laser visual acuity was